For more than a decade, one of my jobs included maintaining a curated online resource directory addressing all things environmental, safety and health. The directory was first begun as the internet powered up with few effective search engines available. And certainly no artificial intelligence! Over the years as search engines perfected what they did, this resource directory was less important. And yet, today, with the overload of fact and fiction available on technical topics, it makes one wonder. Add to this the challenge of explaining not yet fully understood science-generated data with the lay reader? The result can be cumbersome, sometimes false with frequently nuanced explanations we sort through online. Hard to understand? Yes. Indefinite? Sometimes. Frustrating to many? Often. Too complicated to explain? Maybe. Yet trying to simplify what we know sometimes makes our knowledge sound more definite than it is.

A newer friend of mine (YS) not formally trained in industrial hygiene or toxicology, shared his several year effort to learn more about toxic materials. During our frequent virtual correspondence we discussed the challenges of uncovering and understanding existing evidence-based information. At his suggestion, we decided to post this blog: his questions and my answers. And because I’m certain I don’t know it all, I brought in my good friend and colleague Dr. Fred Berman to join the conversation. Although I have no unrealistic dreams about this blog becoming viral, we ask that you further this post along if you think it might be helpful to some. And if you have tips or resources, we encourage you to share them in the comments below.

YS (1) How would you describe Environmental Health in terms of its objectives? What do you, as a collective profession, try to achieve? (I understand that environmental health and safety also sometimes encompass public health and epidemiology.) When lay people like myself hear the terms public health or epidemiology, we (really I) think of doctors in hospitals, in white lab coats, looking over clip boards with patients’ names and their history of illness. Are all CIHs trained in epidemiology?

Dede: In modern day, certified industrial hygienists have technical education – often through the masters or even the doctoral level including coursework in epidemiology, biostatistics and toxicology, as well as other public health offerings such as infectious disease, radiation safety, and ventilation among others. Additionally, throughout our career we must complete continuing education. For some, our education in those specific offerings might be limited to a course or two, while others may specialize in one or more. For me, I hoped to be well-rounded in these different subjects so to be able to better consume the information around us and digest it for our employers, clients or stakeholders. A lot of it is knowing where to look and what information sources to trust. I’ve considered myself to be more of a generalist but I also know what I don’t know, and as importantly, who tor where to go for better understanding or knowledge. I believe one of the most important things to gain over a career are the connections to people and programs that truly are the experts on specific problems and topics.

Fred: My background is in veterinary comparative medicine and toxicology. To me, the broad, overall objective of Environmental Health is to foster safe and healthy environments, not only in the workplace, but in our homes, communities and the overall environment we live in. This would include not only our physical well-being, but also our psychological well-being. From a worker perspective, this is the concept of Total Worker Health as promoted by the National Institute of Occupational Occupational Safety and Health (NIOSH).

When I think of public health or epidemiology, I’m thinking of all the things that make a positive difference to the public, not just the individual. This would include the development of vaccines (human and animal….think rabies, for instance), or the (controversial in some circles) use of fluoride in drinking water to prevent tooth decay, sanitary infrastructure, etc.; actions and developments that have extended the overall health and average lifespan of all people. But it is in the daily activities of individual health care workers and others that these larger goals are achieved.

YS (2) As professionals we internalize our training and knowledge, and it becomes part of our daily thinking process. As an industrial hygienist and, therefore, a person trained to recognize risks, what are the top things that jump out at you in the non-occupational world that make you shake your head as a professional, and why? In other words, what do you see most commonly jump out at you.

Dede: I’m always reminded of a workshop I attended decades ago about Risk Communication (by Peter Sandman) which included a discussion of voluntary versus involuntary risks, as well as the outrage associated with taking on risks involuntarily. I think the biggest impact to health for most people often are the lifestyle choices we make: smoking, drinking alcohol or using drugs, tanning, eating a high fat, sugar or meat laden diet, not getting enough sleep or exercise, always using a seat belt and driving safely, and even living with continual high stress. For many of us, these risks we might take aren’t as unknown or “scary” as things we might be exposed to or when we don’t “voluntarily” choose the exposure. That’s not to say that toxic substances can’t also be harmful, because they can. But many experts remind us how much we can provide a buffer of protection by doing these other things too, not simply avoiding toxic chemicals. When it comes to toxic chemical exposures, it is critical that we do our best to identify 1) what is the problem; 2) what are the potential sources or cause of the problem; and 3) how to control (or remediate) it. In industrial hygiene lingo we often say our job is to identify (what is it?), evaluate (how toxic is it? how much is there? where is it or what exposure routes are of concern?); and control it (can we remove or stop the exposure, substitute something else, require personal protective equipment, use better engineering controls, etc.)

Fred: I am currently a co-investigator with the National Pesticide Information Center (NPIC), which is funded jointly by EPA and Oregon State University. We provide objective information about pesticides, and pests (including insects, weeds, certain animals, bacteria…), both on the Web and directly via phone and email. From the calls we receive, I often shake my head at the creative ways that people mis-use pesticide products. In the pesticide world, “the label is the law”: however, we don’t seem to be a label reading community. My concern is that, when we choose to use these products, we need to do so in a way that minimizes the risk (to humans, non-target species and environment) and maximizes the intended effect. The pesticide label provides the “who, what, where, when and how” of its use so that risk is minimized and effect maximized.

YS (3) What’s one of the most difficult situations you’ve had in trying to evaluate and communicate risks of a substance to someone?

Dede: Two situations come up for me in which I felt similarly distraught, but for different reasons. The first was in the early days of discovering significant amounts of methylene glycol (the liquid substance that can produce formaldehyde gas when heated) in a popular salon hair product. I struggled when I first talked to stylists who had such significant adverse health effects after using the product that they couldn’t work in the salon. Yet they were being told over and over again by the distributor and the manufacturer that it was safe, and it was just something only they were complaining about. In this instance, the science was strong about it being a toxic chemical with significant exposure risk and yet the power of the beauty industry and the product’s money-making potential made it a long and complicated process to successfully get the word out about its risks. It’s taken nearly 15 years for FDA regulations to catch up with the problem.

The other situation was a call I received from a man who had been traveling abroad and living temporarily in short-term housing with his wife. Upon his return to the states he began to develop what appeared to be a significant neurological condition that he was certain was related to something that was released in that rental apartment. He went through all the channels of reaching out to the apartment owner and the authorities. I searched news and other information sources and found nothing that seemed to address what was happening to him. On at least two occasions he went to the emergency room with symptoms, and felt the ER doctors unhelpful, even when they called the Poison Center for ideas, and at one point he got the feeling they thought he was psychotic. I attempted to offer support and ideas for him, but in the end, there was really nothing that was science-based or particularly supportive that I could help him with. I don’t know his final outcome. Those are the cases that we really can’t understand. They might be a mental health reaction, or might there be some genetic predisposition to some thing at sometime that is set off a series of symptoms that are connected to a certain time period or exposure? I’d love to hear Fred analysis of this one.

Fred: What is sometimes difficult for me is when peoples’ perception of risk are skewed by what is read in the media and on the Web. And, it is often hard to discuss with someone, that risks they perceive may not be the ones to be most concerned about. An example concerning pesticide use in agriculture: many are terrified that they are being poisoned by the food they eat due to pesticide residues. This is understandable given the mixed messages we get from the media. However, and this is hard to explain, we have very complex and comprehensive systems in place to minimize, to minuscule levels, the risk posed by pesticide use. These systems have served us well so far inasmuch as the benefits have far exceeded the cost to the population. This is not to say we shouldn’t be concerned, and numerous examples of problems, such as agricultural worker exposures, exist and need to be addressed. Moreover, we can always strive to use other tools in our pest control toolboxes. And, since pesticide use in agriculture is expensive, an integrated pest management approach is one actively incorporated by many.
Along the same lines, the risk posed by what is commonly kept under our kitchen sinks exceeds the risk we perceive “out there”. This is because, once sold to the consumer, the use of pesticides and cleaning products, for example, are not regulated at all. This is not true for agriculture, where the use of chemical agents is tightly regulated, monitored and controlled through licensing, training and legal consequence from mis-use.

Dede: In summary with all of this, both experts and consumers need to try to first define the problem itself, or the “how” of it. Then we try to figure out the “why” as we look at root causes and other contributing factors. When we are fortunate, we find an answer and can move on to propose solutions. Sometimes when the health outcomes are particularly devastating or if we have less science to rely on (e.g., cancer or reproductive effects) we make more stringent exposure limitations. Yet, even then, none of us knows for sure what the safe exposure is. I suspect sometimes it is easier to communicate the conservative recommendations rather than trying to explain the uncertainties. Perhaps that’s a lesson for all of us as we may not be helping folks if we simply freak them out that everything is toxic.

What do you think? We’d love to hear from you.